A Longitudinal Study of Inflammatory Pathways in Depression
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 130
- 试验地点
- 1
- 主要终点
- Establish metabolic biomarkers that indicate risk for suicidal behavior
研究概览
简要总结
Suicide accounts for at least 1 million deaths globally each year. This is likely a significant underestimate, because suicide is under-reported in many countries. In the US, over 42,000 people die from suicide annually. Despite increased focus on identification and treatment, the rate of suicide has increased steadily over the past 15 years.
Our project aims both to improve our understanding of factors that increase the risk for suicide by comparing blood biomarkers associated with inflammation in patients with depression without suicidal behavior and patients with depression and suicidal behavior. The 160 individuals in this study will be followed with psychiatric assessments and blood samples at repeated time points over one year.
详细描述
Suicide is a leading cause of death in the US, and its rate continues to increase. Most individuals who die by suicide are in contact with health care, but clinical risk assessment is challenging. Inflammatory biomarkers have tentatively been linked to suicide. However, longitudinal studies establishing their accuracy in tracking suicidal behavior and critical symptoms are lacking. This study is a longitudinal study, with 1,280 total assessments planned, measuring suicidal ideation and behavior, associated clinical symptoms and blood biomarkers of inflammation.
Our overriding aim is to identify a set of biomarkers that distinguish patients with suicidal behavior from depressive patients without suicidal behavior. Further, the investigators intend to define biomarkers that are elevated during active suicidal behavior (at- risk periods) within the same patients (longitudinally).
Our working model is that inflammation (via pro-inflammatory cytokines) induces the kynurenine pathway, leading to an increased production of neurotoxic kynurenine metabolites (i.e., the NMDA-receptor agonist quinolinic acid, or others), which trigger suicidal behavior. The Investigators predict that immunomodulatory cells and molecules, including cytokines and kynurenine metabolites in plasma, may constitute biomarkers of suicidal behavior. The Investigators also predict that elevated inflammatory markers in suicidal individuals will be associated with epigenetic changes, regulating the expression of kynurenine enzymes in blood cells.
Aims:
- Establish biomarkers that indicate risk for active suicidal behavior;
- Determine epigenetic markers in the blood of patients with suicidal behavior.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men and women ages 18 years and older will be included in the study.
- •80 who are diagnosed with MDD by SCID but do not endorse current or past suicidal behaviors.
- •80 who are diagnosed with MDD by SCID and endorse current suicidal behavior as defined by C-SSRS (preparatory acts, aborted or interrupted attempts, as well as completed attempts).
- •English speaking.
- •Willing and able to take part of the different steps in the study, including follow-up interviews and blood draws.
排除标准
- •Vulnerable populations (e.g. incarcerated individuals).
- •Subjects with dementia or otherwise cognitively impaired subjects with difficulty understanding the study procedures.
- •Patients with a primary psychiatric diagnosis other than MDD.
- •Patients with an active somatic disorder primarily involving the immune system (autoimmune diseases such as Crohns disease, multiple sclerosis, or rheumatoid arthritis; or hematological diseases such as lymphoma or leukemia).
- •Patients on chronic and systemic immunomodulatory treatment. Examples are patients with a liver- or kidney transplant or medications used for disorders involving the immune system, as mentioned above. Examples of immunomodulatory treatments are cyclosporin, azathioprine, infliximab, corticosteroid treatment.
- •Patients undergoing active treatment for any form of cancer (chemotherapy or immunomodulatory treatments).
结局指标
主要结局
Establish metabolic biomarkers that indicate risk for suicidal behavior
时间窗: One year.
Evaluate if metabolic biomarkers are predictive of suicidal behavior (planning, attempting) among patients with depression. Metabolites will be measured by high-pressure liquid chromatography, ultra-high performace liquid-chromatography and gas-chromatography mass-spectrometry). The main metabolite biomarker outcomes are quinolinic, kynurenic and picolinic acids as well as 3-HK and kynurenine (nM).
Suicidal behavior of participants
时间窗: One year.
The presence of suicidal behavior over one year will be classified as yes/no as the primary outcome measure. The Identification of participants with suicidal behavior at each study time point will be achieved by assessment using the Columbia Suicide Severity Rating Scale (C-SSRS) regarding attempt, interrupted or aborted attempt, or preparatory acts over the past 7 days.
Determine epigenetic marks in blood cells from patients with suicidal behavior
时间窗: One year.
DNA methylation will be measured by Illumina Infinum methylationEPIC BeadChip microarrays, and compacted between patients with suicidal behavior and patients without suicidal behavior.
Establish inflammatory biomarkers that indicate risk for suicidal behavior
时间窗: One year.
Evaluate if inflammatory biomarkers are predictive of suicidal behavior (planning, attempting) among patients with depression. Inflammatory markers will be measured using high-sensitivity ELISAs, Mesoscale platform or Luminex platforms. The main cytokine outcomes are TNF-alpha and IL-6 (pg/ml).
Functional validation of the significant methylation changes
时间窗: One year.
mRNA will be quantified by qPCR in the same peripheral blood samples as used for the EPIC array for functional validation of the significant methylation changes.
次要结局
未报告次要终点
研究者
Lena Brundin
Associate Professor
Van Andel Research Institute